Clinical and epidemiolgical characteristics of infectious keratitis at Fundación Banco de Ojos "Fernando Oca del Valle" in Paraguay

Abstract

 

Purpose:

 

To describe the clinical and epidemiological characteristics of patients with severe infectious keratitis at Fundación Banco de Ojos (FBO) Eye Hospital, Asunción, Paraguay between April 2009 and September 2011.

 

Methods:

 

All patients with the clinical diagnosis of severe keratitis (ulcer ≥2mm in size and/or central location) were included in this study. Demographic and clinical data as well as the treatment, the clinical outcome and risk factors were analyzed. Empiric treatment consisted of topical antibiotics (moxifloxacin 5mg/ml) and antimycotics (fluconazol 2mg/ml); in cases of advanced keratitis fortified antibiotics were used (cefazolin 50mg/ml or vancomicin 50mg/ml + gentamicin); in case of suspected Pseudomonas aeruginosa ceftazidim 50mg/ml was used. After microbiological analysis, the treatment was changed if indicated. In case of mycotic keratitis, patients were treated topically every hour either with natamicin 5% or fluconazol 0.2% and moxifloxacin 4 times a day. In case of bacterial keratitis, topical moxifloxacin was used and in advanced cases cefazolin or vancomicin for gram positive bacteria, gentamicin for gram negative ones and ceftazidim in case of Pseudomonas aeruginosa,all of which were applied every hour.

 

Results:

 

In the study period, 48 patients (62.5% males, 25% farmers) were included in the analysis. In 62.5% of cases (n=30) the patients seeked medical help because of a painful red eye. A central location of the ulcer was found in 81.3% (n=39). The delay between the onset of symptoms and the time of first presentation at our institution was 7 days (median, range 1 - 30 days). In 64.5% (n=31) of patients fungal keratitis was diagnosed, of which Fusarium spp (n=17) was the most common. With regard to risk factors, 21 patients reported previous trauma to the eye, 18 patients the use of some kind of previous treatment and 3 the use of contact lenses. In 22 patients follow-up was possible. These patients could be cured by topical therapy; however in 5 of these an additional conjunctival flap was necessary, while evisceration/enucleation had not to be performed in a single patient.

 

Conclusions:

 

The high rate of fungal keratits which was found in microbiological culture is remarkable and much higher than the rates published in studies from the United States. Microbiological analysis of the specimen provided valuable information for the appropriate anti-fungal treatment in these patients. With intensive treatment and regular controls the active infection could be controlled in many patients. However central scars may persist and keratoplasty may be necessary. In our setting, we have to be highly suspicious of fungal causes of infectious keratitis.

 

Keywords: keratitis • fungal disease • antibiotics/antifungals/antiparasitics